Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy
CPT4 code
Name of the Procedure:
Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy
Summary
This procedure involves removing and replacing an osseointegrated implant located in the temporal bone. The implant is connected to an external speech processor or cochlear stimulator but does not require a mastoidectomy, which is the surgical removal of part of the mastoid bone.
Purpose
The procedure aims to improve or restore hearing in individuals with hearing loss due to malfunctioning or outdated implants. By replacing the existing device, patients can achieve better hearing function and overall quality of life.
Indications
- Malfunctioning or damaged osseointegrated implants
- Poor hearing performance of the current device
- Upgrading to a newer or more advanced implant
- Chronic infections or discomfort associated with the current implant
Preparation
- Patients may need to fast for several hours prior to the procedure.
- Discontinue certain medications as advised by the healthcare provider.
- Preoperative assessments including hearing tests, imaging studies, and blood tests.
Procedure Description
- Anesthesia is administered to ensure patient comfort.
- The existing implant is carefully exposed and removed from the temporal bone.
- The site is prepared for the new implant, ensuring a good fit and optimal positioning.
- The new osseointegrated implant is placed into the bone, ensuring secure attachment.
- The external percutaneous attachment is connected to the implant, allowing for connection to the speech processor or cochlear stimulator.
- The surgical site is closed and bandaged.
Duration
The procedure typically takes between 1 to 2 hours.
Setting
The procedure is usually performed in a hospital or a specialized surgical center.
Personnel
- ENT (Ear, Nose, and Throat) Surgeon
- Surgical nurses
- Anesthesiologist
- Audiologist (for device fitting post-surgery)
Risks and Complications
- Infection at the surgical site
- Device malfunction
- Bone infection (osteomyelitis)
- Skin irritation or allergic reactions
- Failure of osseointegration (the implant not properly bonding with the bone)
- Potential for anesthesia-related complications
Benefits
- Improved hearing capabilities
- Enhanced quality of life with better communication
- Compatibility with advanced hearing technologies
- Typically noticed improvements within a few days to weeks post-surgery
Recovery
- Detailed care instructions including wound care and activity restrictions
- Prescription for pain management, if necessary
- Follow-up appointments to monitor healing and program the new device
- Most patients can return to normal activities within a few weeks
Alternatives
- Continued use of current implant with adjustments
- Conventional hearing aids
- Non-surgical bone conduction devices
- Each alternative has its own set of benefits and limitations, and choices depend on patient-specific factors and preferences.
Patient Experience
- During the procedure, patients are under anesthesia and will not feel pain.
- Post-procedure, there might be some discomfort and swelling around the surgical site.
- Pain is managed with medications as needed.
- Patients may feel periodic adjustments as the body adapts to the new implant.